Decision could pave way for Medicaid expansion in W.Va.

CHARLESTON, W.Va. -- West Virginia is poised to become a leader in implementing federal health-care reform now that the U.S. Supreme Court has upheld the Affordable Care Act, state lawmakers said Thursday.

Leaders of the House and Senate health committees said West Virginia should take part in the federal law's expansion of Medicaid, which provides free health care to the poor. About 130,000 additional West Virginians would become eligible for Medicaid.

"I fully anticipate we will embrace the expansion of Medicaid," said House Health and Human Resources Chairman Don Perdue, D-Wayne. "This would enable the working poor to provide health care to their families and will obviously improve their health and their lives."

West Virginia lawmakers also said the state could now move swiftly to finish a health insurance exchange program that would provide subsidized insurance to West Virginians under the federal health-care reform law.

"We already have some of the infrastructure in place to move forward," said Senate Health and Human Resources Chairman Ron Stollings, D-Boone. "The key, though, is to make personal responsibility a part of this. If people have 'skin in the game' and have to pay something, they tend to use health-care dollars more wisely."

Meanwhile, House Republican leaders said West Virginia would be foolish to move ahead with the health exchange. They said the health-care law could be repealed if President Obama loses the November election and Republicans take over the U.S. Senate.

"Those are real possibilities," said House Minority Leader Tim Armstead, R-Kanawha. "It would be irresponsible for us to forge ahead and implement this. We should repeal the health-care exchange."

But Perdue said West Virginia was already "ahead of the curve" with the health exchange and shouldn't stop now. As many as 250,000 West Virginians could be eligible to sign up for the program, which would offer discounted health insurance premiums.

"We have a lot of work to do, but we don't have as much work to do as most states," Perdue said. "We were in a holding pattern [while waiting for the Supreme Court decision], but at a higher altitude than most states."

Armstead said West Virginia also should not expand Medicaid eligibility, predicting the expansion the program's costs would skyrocket.

"It's been a huge cost for our state," he said. "I don't think we can absorb those costs."

On Thursday, the Supreme Court made changes to the health-care law's Medicaid expansion. The court said states wouldn't lose their existing Medicaid funding if they don't comply with the law requiring expanded Medicaid eligibility to more poor Americans.

Perdue predicted that the increased number of Medicaid recipients under the expansion wouldn't lead to increased health-care costs. He said "uncompensated care" costs -- for people receiving care but not paying for it -- would decline.

"With a cost-benefit analysis, I would think the benefit would clearly far outweigh the cost," Perdue said.

In West Virginia, Medicaid covers people who make no more than 38 percent of the federal poverty level, or about $6,000 a year. Under the Medicaid expansion, coverage would be provided to those who make 138 percent of the federal poverty level, or up to about $15,000.

For several years, the federal government will pay 100 percent of the state's Medicaid expansion costs under the new law. The federal share would drop to 90 percent in future years.

"This will bring in a huge amount of federal dollars to assist the state in establishing this program and providing a meaningful health-care benefit," Perdue said. "It's just simple mathematics. It's going to cost us more if we don't do it."

Sen. Dan Foster, D-Kanawha, said West Virginia stands to benefit more than any other state.

"This is a good deal for the states," said Foster, a physician at Charleston Area Medical Center. "West Virginia is potentially going to get more than any other state. Hopefully, more and more people with get health care, and lives will be saved."

U.S. Sen. Jay Rockefeller said Thursday's Supreme Court decision "leaves in place an enormous financial incentive for states to do the right thing and expand coverage."

"I hope every state will do that, because these are good people who effectively have no other realistic option for affordable health care," Rockefeller, D-W.Va., said in a statement.

He also urged West Virginia and other states to accept the Medicaid expansion.

"The decision still leaves in place an enormous financial incentive for states to do the right thing and expand coverage to this group," Rockefeller said.

Sen. Joe Manchin said he has worked to reduce the Medicaid expansion's financial burden on states.

"This ruling affirms my position, and makes clear that states must have the flexibility to live within their means by determining Medicaid eligibility as each state sees fit," Manchin, D-W.Va., said in a prepared statement. "I have always said one size doesn't fit all."

In a release, U.S. Rep. Shelley Moore Capito said she respects the Supreme Court's decision, but believes "this law is bad for West Virginia families and the American economy."

"For the past two years, I have listened to West Virginia caregivers, small business owners, doctors and constituents who overwhelmingly say that the President's health-care law is the wrong direction for America," said Capito, R-W.Va.

On Thursday, state lawmakers agreed that Obama's health-care law wasn't perfect. But they said the Affordable Care Act -- and the Supreme Court's ruling -- were important steps to fixing West Virginia's health-care problems.

"We have finally broken the vase," Perdue said. "Now that the vase has been shattered, we can put it back together in a far more productive way so we can improve people's health.

"Today was a good day. It absolutely was an amazingly good decision by the Supreme Court."